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Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news: Update 23 May 2019

Although this past week continues to bear witness to a steady rise in the number of Ebola virus disease (EVD) cases in the Democratic Republic of the Congo, the overall security situation has allowed for the resumption of most response activities. While
no major insecurity incidents have occurred, outbreak response teams, local healthcare workers, and community members cooperating with response efforts, are increasingly subjected to threats made against them by armed groups present in hotspot areas such as
Katwa and Butembo. These threats are often disseminated through leaflets or direct intimidation. Armed groups’ presence, activities and increasing direct threats against response teams continue to be reported in other EVD affected areas, in particular
Lubero, Masereka, Mabalako, Kalunguta, and Vuhovi, resulting in some healthcare workers being unwilling to don personal protective equipment or perform critical Infection Prevention Control (IPC) measures out of fear of violence being levied against them or
the healthcare facilities where they operate.

During the past three weeks, reports indicate that transmission remains most intense in seven main hotspot areas: Beni, Butembo, Kalunguta, Katwa, Mabalako, Mandima, and Musienene. Collectively, these health
zones account for the vast majority (93%) of the 349 cases reported in the last 21 days between 1 - 21 May 2019 (Figure 1 and Table 1). During this period, new cases were reported from 91 health areas within 15 of the 22 health zones affected to date (Figure
2).

As of 21 May, a total of 1866 confirmed and probable EVD cases have been reported, of which 1241 died (case fatality ratio 67%). Of the total cases with recorded sex and age, 56% (1051) were female and 30% (545) were children aged less than 18 years.
The number of healthcare workers affected has risen to 105 (6% of total cases). 490 EVD patients who received care at ETCs have been successfully discharged.

Figure 1: Confirmed and probable Ebola virus disease cases by week of
illness onset by health zone. Data as of 21 May 2019*

Figure 2: Confirmed and probable Ebola virus disease cases
by health area, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 21 May 2019

Table 1: Confirmed and probable Ebola
virus disease cases, and number of health areas affected, by health zone, North Kivu and Ituri provinces, Democratic Republic of the Congo, data as of 21 May 2019**

WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is
adapted to the evolving circumstances. The last assessment concluded that the national and regional risk levels remain very high, while global risk levels remain low. Weekly increases in the number of new cases has been ongoing since late February 2019. A
general deterioration of the security situation, and the persistence of pockets of community mistrust exacerbated by political tensions and insecurity, have resulted in recurrent temporary suspension and delays of case investigation and response activities
in affected areas, reducing the overall effectiveness of interventions. However, recent community dialogue, outreach initiatives, and restoration of access to certain hotspot areas have resulted in some improvements in community acceptance of response activities
and case investigation efforts. The high proportion of community deaths reported among confirmed cases, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains linked to nosocomial infection, persistent
delays in detection and isolation in ETCs, and challenges in the timely reporting and response to probable cases, are all factors increasing the likelihood of further chains of transmission in affected communities and increasing the risk of geographical spread
both within the Democratic Republic of the Congo and to neighbouring countries. The high rates of population movement occurring from outbreak affected areas to other areas of the Democratic Republic of the Congo and across porous borders to neighbouring countries
during periods of heightened insecurity further compounds these risks. Additional risks are posed by the long duration of the current outbreak, fatigue amongst response staff, and ongoing strain on limited resources. Conversely, substantive operational readiness
and preparedness activities in a number of neighbouring countries have likely increased capacity to rapidly detect cases and mitigated local spread. However, these efforts must continue to be scaled-up at this time.

WHO advice

WHO advises against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on the currently available information. There is currently no licensed vaccine to protect people from the Ebola virus. Therefore, any requirements
for certificates of Ebola vaccination are not a reasonable basis for restricting movement across borders or the issuance of visas for passengers leaving the Democratic Republic of the Congo. WHO continues to closely monitor and, if necessary, verify travel
and trade measures in relation to this event. Currently, no country has implemented travel measures that significantly interfere with international traffic to and from the Democratic Republic of the Congo. Travellers should seek medical advice before travel
and should practice good hygiene.

Many become homeless after losing their jobs and homes due to HIV/AIDS and the shame
that often accompanies the disease. Your donation
to AFH transforms lives in a way that handing out change at intersections never will. Jeanetta's story shows how.

Despite growing up in poverty, Jeanetta* worked hard to get an education and land a good job.Then
she became sick with what she thought was the flu. She was shocked when her doctor revealed that tests showed she was HIV-positive.Used to hearing AIDS used as the punchline of jokes, she slid into shame and depression.

A recent study found 50% of HIV+ individuals have felt at risk of becoming homeless.

Between too many sick days and simply feeling too sad to go to work, Jeanetta lost
her job. No longer able to afford her apartment, she soon joined the army of homeless who beg on street corners.

One day Jeanetta walked up to the window of a car with her homemade sign only to see the surprised face of a former coworker looking back.
She turned to walk away but heard her name being called. Reluctantly, she turned around. Two hours later, after many tears and her first decent meal in months, her life had changed. Her former coworker was an AFH volunteer who told
her about our housing programs, food pantry, and support services.

Jeanetta now lives in our housing program for HIV+ women. Her HIV is under control and her health has improved. Counseling and access to health care have helped her develop
a more positive outlook. Jeanetta tells us she feels ready to look for a new job. Her life was changed by donors like you!

Choose the giving method easiest for you: Click DONATE NOW to give via our website, text HOPE to (713) 909-4129 to make a text donation, or send a check to
the address at the bottom of this email with the word "HOPE" in the memo field. When you do, you will improve the plight of the homeless and reduce the number of new HIV cases in our community. Thank
you for supporting these vital programs!

Thanks to all of you who dined out to fight HIV/AIDS and to the restaurants and sponsors who made this event
possible!

How does Dining Out For Life make a difference?

Participating restaurants across Houston committed a portion of their proceeds to AIDS Foundation Houston and our work to end the spread of HIV/AIDS.
Everyone who dined out increased the amount these restaurants made, and therefore the amount they donated to AFH!

Please give today to support the AFH’s work including providing
permanent housing and nutritional support for homeless HIV+ Houstonians; linkage to medical care and other supportive services; and testing, education, and prevention efforts.

CBO Reaffirms Dangers Of Single-Payer Health Care System

WASHINGTON, D.C. – The House Budget Committee today held a hearingwith the Congressional Budget Office (CBO) to discuss its recent report on imposing a one-size-fits-all, single-payer health care system, as Democrats’ Medicare-for-All
proposal would do. The hearing today reaffirmed many of the risks associated with this approach, including:

Outlawing Americans’ Existing Coverage

“I think all of us want to provide insurance
for those who don’t [have it], I don’t know a single person who doesn’t want to achieve their goal, but I also know that something like 60 percent of Americans don’t want to lose their private insurance, and don’t want to be held
outside of the law if they were to choose to do that.”— Rep. Chris Stewart (R-UT)

Disrupting Seniors’ Care

“Our seniors who currently rely on Medicare would
have their care disrupted too. After a lifetime of work to earn their Medicare benefits, American seniors would be forced into a one-size-fits-all, government-run health care system, no longer tailored to the needs of our older citizens, but one that rations
care and limits their access.”— Rep. Jason Smith (R-MO)

Exposing Americans’ Personal Information

“Yes absolutely.”— CBO
Deputy Director Mark Hadley in response to Rep. Bill Johnson (R-OH) asking if the security for the standardized IT system needed to establish and operate a single-payer health care system should cause concern.

“This system ends up hurting patients with the most unique conditions, also known as patients with pre-existing conditions, because
their care requires flexibility and innovation, both of which are drastically reduced in a single-payer system.” — Rep. Dan Crenshaw (R-TX)

Making It More Difficult To See Your Doctor

“If
there is a mismatch between the demand for care and the supply of care, then you would end up with increased wait times and problems with access to care. … That might mean needing to travel further distances to see doctors.” —Deputy
Director Hadley, when asked by Rep. Dan Meuser (R-PA) about the potential impact of a single-payer system on the supply of doctors.

Disadvantaging Low- and Middle-Income Americans

“I don’t
know about the elites, but I’ll go with the wealthy.”— Deputy Director Hadley confirming for Rep. Stewart that only the wealthiest Americans would be able to afford additional services beyond what a public plan covers.

As Ranking Member Womack put it:

“This is the direction some lawmakers want to take your health care – and it will have consequences that ripple through the most personal aspects of American life, from fewer doctors
and longer wait times to less access and no choices.”

Geneva, 22 May 2019 – Algeria and Argentina have been officially recognized by WHO as malaria-free. The certification is granted when a country proves that it has interrupted indigenous transmission of the disease for at least 3 consecutive years.

Contracted through the bite of an infected mosquito, malaria remains one of the world’s leading killers, with an estimated 219 million cases and over 400 000 malaria-related deaths in 2017. Approximately 60% of fatalities are among children aged under 5 years.

Algeria is the second country in the WHO African Region to be officially recognized as malaria-free, after Mauritius, which was certified in 1973. Argentina is the second country in the WHO Region of the Americas to be certified in 45 years, after Paraguay in June 2018.

Algeria and Argentina reported their last cases of indigenous malaria in 2013 and 2010 respectively.

An ‘unwavering commitment’

For both Algeria and Argentina, malaria has a history that spans hundreds of years, and the battle against the disease has been hard-fought. Over the last decade, improved surveillance allowed for every last case of malaria to be rapidly identified and treated. Importantly, both countries provided free diagnosis and treatment within their borders, ensuring no one was left behind in getting the services they needed to prevent, detect and cure the disease.

“Algeria and Argentina have eliminated malaria thanks to the unwavering commitment and perseverance of the people and leaders of both countries,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Their success serves as a model for other countries working to end this disease once and for all.”

Stamping out malaria in Algeria

French physician Dr Charles Louis Alphonse Laveran discovered the malaria parasite in Algeria in 1880. By the 1960s, malaria had become the country’s primary health challenge, with an estimated 80 000 cases reported each year.

Algeria’s subsequent success in beating the disease can be attributed primarily to a well-trained health workforce, the provision of malaria diagnosis and treatment through universal health care, and a rapid response to disease outbreaks. Together, these factors enabled the country to reach – and maintain – zero malaria cases.

“Algeria is where the malaria parasite was first discovered in humans almost a century and a half ago, and that was a significant milestone in responding to the disease,” said Dr Matshidiso Moeti WHO Regional Director for Africa. “Now Algeria has shown the rest of Africa that malaria can be beaten through country leadership, bold action, sound investment and science. The rest of the continent can learn from this experience.”

Argentina’s road to elimination

In the 1970s, Argentina set out to eliminate malaria. Key elements of its approach included training health workers to spray homes with insecticides, diagnosing the disease through microscopy, and effectively responding to cases in the community.

Cross-border collaboration was also critical. Between 2000 and 2011, Argentina worked closely with the Government of Bolivia to spray more than 22 000 homes in border areas and conduct widespread malaria testing.

“Argentina reported the last indigenous case in 2010 and has demonstrated the commitment, the capacity within its health, laboratory and surveillance systems, and the necessary financing to prevent the re-establishment of malaria within the country”, said Dr Carissa F. Etienne, Director of the Pan American Health Organization, WHO regional office for the Americas “I am sure that Argentina will serve as an inspiration and as an example for other countries of the Americas to achieve the elimination of malaria in the coming years.”

The certificates will be presented by the WHO Director-General to representatives from Algeria and Argentina on the sidelines of the 72nd session of the World Health Assembly.

WHO grants a certification of malaria elimination when a country has proven, beyond reasonable doubt, that the chain of indigenous transmission has been interrupted nationwide for at least the previous three consecutive years. In addition, a national surveillance system capable of rapidly detecting and responding to any malaria cases must be operational, together with an effective programme to prevent re-establishment of the disease.

Globally, a total of 38 countries and territories have now been declared malaria-free:https://www.who.int/malaria/areas/elimination/malaria-free-countries/en/

Details on the WHO malaria elimination certification process can be found at: https://www.who.int/malaria/areas/elimination/certification/en/

Seventy-second World Health Assembly

The 72nd annual World Health Assembly will take place from 20 to 28 May 2019 at the Palais des Nations
in Geneva, Switzerland. It will be attended by nearly 4000 delegates from WHO’s 194 Member States and partner organizations. The Health Assembly is WHO’s highest decision-making body, setting out the Organization’s policy and approving its
budget.

The general theme of this year’s World Health Assembly (WHA) is "Universal health coverage: leaving no-one behind".

The Assembly will be webcast live, including the plenary sessions and the deliberations in Committees A and B. WHO will send and post daily press releases, detailing decisions taken at the Health Assembly.

Walk the Talk: The Health for All Challenge 2019

To kick off the work of the Assembly, WHO is organizing
a second Walk the Talk: The Health for All Challenge 2019, starting 9.30am at Place des Nations on 19 May.

The Challenge is a celebration of the importance of health and a recognition of the vital role that the city of Geneva plays as a hub for global health.

The First Lady of Kenya, H.E. Mrs Margaret Kenyatta, will be the special guest at this event and
she will be joined by other champions of sports and health including: champion runner Tadesse Abraham; champion marathon runner Mary Keitany; and mental health advocate Cynthia Germanotta (co-founder of Born This Way Foundation with her daughter, Lady Gaga).

Monday 20 May

World
Health Assembly Opens

The Health Assembly will open with a high-level segment, which will include an address by WHO Director General, Dr Tedros Adhanom Ghebreyesus, at around
12 noon. The entire event will be webcast. A number of Health Leader Awards will be announced during the morning and a photo opportunity will be held outside the Salle des Assemblées at the end of the high-level segment.

Live webcast

The Assembly will be webcast live, including the plenary sessions and the deliberations in Committees A and B.

Press briefings

21 May | 10h30 | Salle de presse III

22 May | 10h30 | Salle de presse I

23 May | 10h30 | Salle de presse I

24
May | 10h30 | Salle de presse III

27 May | 10H30 | Salle de presse I

On Tuesday 28 May, a closing press conference may be organized. This and any additional briefings will be announced
by email.

The Agenda

Click here for the agenda and other documentation in the 6 official languages.

Access to meetings

Committee A and Committee B and the Assembly Hall are open to media and can be covered from specially-designated press areas. Please consult the Journal for information on whether other meetings are open or closed. To avoid access issues, journalists must
wear their accreditation badges visibly.

The Journal

A Daily Journal will be posted on the WHO website every morning from 20 May.